This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Friday, 1 January 2010

Slapheads: RGN version

I am a big fan of Mental Nurse and wanted to copy their slaphead series. They've done RMN,s, HCA's, Patients, etc in their slaphead posts. Here I go with an RGN's version, the militant medical nurse way. If you think I am a shameful copy cat just let me know in the comments section.

Of course none of the following applies to myself or my current colleagues. We are super nurses and should have a cape to go along with our superpowers. I have run into some real freaks over at HCR Manorcare in my years and years of nursing.

Indeed I have, in my time, run into all of the following charactors listed below. Repeatedly. Maybe you have as well.

Coasting till Retirement Colleen- Colleen did her training long before I was born. She used to be a fantastic nurse but years of abuse from patients, relatives, colleagues, and management whilst doing an impossible job has destroyed Colleen's spirit. She is a shell of a human being with it's life force sucked out. She arrives to work. and then bursts into tears and does the bear minimum that she can get away with just to get the hell out of there. She snaps at people, locks herself in the treatment room, and looks at students as if they are crazy. Her colleagues have to pick up her slack. She has calenders all over the place, counting down the next year or so until she retires. She have has pen marks on her arm, counting down each minute until the end of her shift. Every painful second gets Colleen closer to retirement. Amen.

Nerdie Nellie---- Nerdy Nellie is going to drive yours truly into alcholism and I don't even drink. Nellie is usually a twentysomething new nurse who takes her job so seriously we have nicknamed her psycho. She comes into work two hours early, unpaid, and leaves two hours late, unpaid and goes over everything with a fine tooth comb repeatedly. If anything goes wrong on the ward, even if it has nothing to do with her she starts weeping and throwing herself on the floor screaming "I'm sorry, I am such a crap nurse, it is a privilidge to be here and I don't deserve it because I am awful". She does observations about twenty times more than necessary. She gets a thousand things done in the time it takes the rest of us to get 10 things done. She never takes a break even if we are not busy because she does not feel that she is deserving. Nellie will work 15 hours straight through on a non busy day, and then apologise to the patients for not being good enough. She spends all of her time outside of work reading nursing journals. If another nurse makes and omission or mistake Nellie goes mad. After she finally does leave work, she calls the ward 10 or 20 times to make sure that all the patients are okay and that she didn't forget anything. All night long. Forgetting is easily done when you have total chaos and too many patients. It upsets all of us but Nellie actually needs medication and a CPN.

Nerdy Nellie and Coasting it Coleen must never be put on duty together or on the same day because sparks fly. A nightmare from hell is Nellie coming on duty and taking over from Coleen. HOLY. SHIT. Meow. But out of all of them , Nellie's are clinically excellent and what I want for my nurse if I am unwell. That is what stops me from strangling her to death. I did ask her once if she ever stopped blaming herself and took a good hard look at patient ratios and multifaceted systems errors. Her eyes glazed over and she stares off into space. It gave her something to think about. Nursing education tells nurses that everything is their fault, even the doc's errors and management incompetence. The universities are churning out Nellie's at an alarming rate. Time to buy stock in pharmacutecal companies that make anti-anxiety meds and anti-depressants.

Lazy Len.... Typical lazy male staff nurse (ooohhh I am going to get some shitty comments for saying that). Len does nothing on the rare occasions that he shows up for work. Nothing. I don't know how the hell these Len's get away with it. He is a master at passing the buck. A master. None of his patients seem to have any pressure ulcer documentation. The reality is that Len just never bothered to look at their skin etc etc etc etc. He hangs around with Pervy Peter and management Molly.

Management Molly... Molly qualifed in the 70's and hasn't been on a ward since. She love magnets, paperwork, targets, and describing the nurses who actually have the balls to show up on the wards as "lacking in compassion". She is clueless. She has no idea what is going on. Once in a blue moon she will do a quick ward walk through on a day where two RN's are struggling to make order out of chaos and care for an appalling high number patients with no staff and resources. She will interrupt them to say "well you don't look very busy, here is a 40 page catheter audit to fill in on every patient with a catheter. " She likes to refer to patients as customers and clients and talk about their journey's through healthcare. But she will not go anywhere near one. I don't know what she does all day but entire forests are dying and she drinks more tea than exists in all of China. When you try and explain to her the actual situation on the wards her eyes glaze over. She has no idea what you are talking about and thinks that you are really nothing but complaining rif raf, complaining for the sake of it.

Crazy Connie....I have run into a few of these and they make me shiver with terror. Luckily the ones I knew were fired. Crazy Connies crush up paracetamol tablets, mix them with tap water, and inject their brew into IV bags. They sport a massive behive and love to wear an old fashioned nurse's cap, white dress, and white stockings. She talks to her dead dog all night long. Out loud. She never bothers with drug charts, if a patient is asking for pain medication she just hands them whatever it is she is carrying around in her handbag. She walks up and down the ward talking to herself, while blaming herself for her boyfriends death in a car accident because "another dude liked me and put a voodoo curse on Rocky to get him out of the way". I do hope that all Connie's get the help that they need and stay the hell away from nursing. The truly scary thing is that I have run into more than one of these types.

Pervie Peter.....typical perverted male staff nurse (am I being offensive? Good. Now let's continue). Todd from Scrubs has got nothing on Staff Nurse Peter.. He lears at you with a sickening grin. Constantly. He constantly tries to look down your tunic top, admits it, and laughs about it. And when you go into the office to do some charting he follows you in and sits way too close. They will not give this guy a nursing student to mentor under any circumstances. He rates the quality of the hospital staff by cup size and their "hotness". He speculates about what kind of knickers the female docs wear. He finds out where you live. And one night when you are on the sofa with your husband watching a movie you look at your window to see Peter with his face pressed up against the glass staring at you. And this is how he interacts with us older middle aged look like hell females. You should see what he puts the younger members of staff through. Hospital management does nothing about Peter types who harass his coworkers. Until he starts on the young female relative of a patient. Then all hell breaks lose and we never see Peter again.

Old Fashioned Alice. .... Alice trained when Christ was a babe in arms and she let's everyone know it when she gives her reasons for refusing to retire. She was brought up on the moors of yorkshire and has an accent to go with it. Her jowels are the size of a small country and she is either huge or extremely tiny. She is so old that agency HCA's didn't realise that she was a nurse and told her to "get back to the bed and ring the bell for help".

Here are some classic Alice-isms: "In our'n day we didn't use gloves, we had shit all over our hands and went from one patient to another and I see no reason to change" In our'n day we smoked at the nurses station, it gave the place an air of sophistication". "In our'n day we didn't have any of this fancy shmancy life saving stuff and it was better and so are coal fires". "What is the point of infection control and IV antibiotics, we didn't ave none of th'at nonsense in our'n day". "I'm making a cuppa for the relatives, and then I'll deal with the bleeder, that's how it was done in our'n day". Coming on duty after Alice's shift blows chunks because you have half of her workload that she ignored to pick up as well as your own. No meds have been given, notes are being burned to heat the fire that Alice thinks we need for heating the ward and patients are deteriorating before your very eyes. But their beds have perfect hospital corners and they have all had a cuppa and a fag. Even the ones on 02 have a fag. Alice doesn't believe that 02 is flammable because "we didn't worry about that shit in our'n day". Oh, and she thinks that modern nurse training is pants and tells mentally ill patients to "BEHAVE".

Should have stayed an HCA Shirley........Shirley had been an HCA from her late 20's until her mid forties. She thought she knew more than the nurses. She thought she ran the ward. She loved to crack jokes at the nurses expense: "Nurses don't change lightbulbs silly, they just document that they did". She repeatedly slagged off the nurses for not doing all the basic care. She didn't do it either, of course. When one nurse had 5 critical patients during a drug round for 30 of them, Shirley would tell the patients "I am the one who does all the real work around here because I am an old fashioned 'nurse'". Then Shirley would go out for a 2 hour fag break and leave the Nurse with 5 critical patients to answer all the call bells alone for 30 people . Then one day Shirley decided to go to nursing school. Despite loads of reservations from her mentors she somehow passed. She nearly didn't and it took her 4 years to do so. She graduates and gets a job on her old ward.

But she cannot handle the nurse workload and makes more drug errors in one day than I have seen in a lifetime. She is in tears from the stress. She just avoids the really sick patients because she is so lost with it all, and goes about still working as an HCA, ignoring critical problems while her colleague does her job for her. She is great at bed bathing and gossiping but has no executive function whatsoever. Constant constant communication errors and fuck ups. Then she goes off sick with stress, resigns (or got sacked), and now works at Primark. Sweet fucking come uppance. I love it.

Happy New Year Everyone! Be a better nurse than the ones on this post!

37 comments:

Anonymous
said...

the strain and excess of xmas, the school holidays and the long day ahead of me tomorrow, have made me grumpy and irritable.............but now i am all cheered up because of your blog. The scary thing is how accurate you are: you describe my ward EXCATLY. unfortunatley i think i am a bit of a connie character. but at least i am not Nellie. i rota my shifts to avoid her.

God, just realised I am a combination of Colleen, Len and Peter. I love Alices' thinking, I remember a lot of that stuff - yes we smoked at the nurses station and we didn't use gloves and it was 'better' (allegedly).

Superb post, just what I needed to cheer me up after 12 hour shifts over New Year.

hello Grumpy and a/e charge and Anne...........guess what i just found out the nhs blog doctor has decided to post. (he is slagging off charles again). will one of you post him a comment to wind him up? the only thing that seems to wind him up is poor grammer. p.s. i hope grumpy that you are not the nurse down in a/e who keeps putting size 18 catheters into men. we have had a run of them recently. i cant help thinking its because you are out of stock of the smaller ones.

I don't work in a&e but we never seem to have any 12, 14 ch catheters in stock. Have to leave my patients for ages to run around and try and track them down. It's not like we have anyone to sort our stock out nor do we have time to do it.

pscychiatry is a black cat - I saw Doc Crippens post, but in this case I agree with him, I have said in the past I only really disagree with him about nurse education and career progression and if he ever calls me 'nursey' I will stick a bed pan so far up it will give him a second adams apple.Also, I do work in A&E, but I very rarely do catheters and the only time I have seen an 18 go in was in urology.

Anne, what do you mean am I saying I am a perv? I positively revel in it ;-) hehehe(dirty laugh). Actually, due to an unfortunate incident involving a nurse with a large chest and ongoing CPR my colleagues have accused me of having a boob fixation. Like most mature adults in a mixed work place we have a fair bit of sexual innuendo going on, mostly at my and the other males expense. No offence taken and no harm done.

Have you ever thought about writing an ebook or guest authoring on other sites?I have a blog based on the same topics you discuss and would love to have you share some stories/information. I know my viewers would value your work.If you're even remotely interested, feel free to shoot me an email.

But, ωhat about this? whаt іf уou were tо wгіte а kіllег hеadlіnе?I ain't saying your information is not solid., but what if you added a post title that grabbed people's attention?I mean "Slapheads: RGN version" is a little boгing.Υou οught to peеκ at Yahoo's home page and watch how they write article headlines to get viewers to click. You might add a related video or a related pic or two to grab people excited about what you've got to say. Just my оpinіon, it mіght bring yоur website a little liνеlіer.

Wow that was strange. I just wrote an incredibly long comment but after I clicked submit my comment didn't appear. Grrrr... well I'm not writing all that over again. Anyways, just wanted to say fantastic blog!

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.